ABSTRACT
Despite standardization, marked interindividual variation in the severity of the disulfiram-alcohol reaction (DAR) has been observed. We studied the DAR in 51 consecutive alcoholics with (n = 16) and without (n = 35) significant alcoholic liver disease. Clinical signs of the DAR were much weaker in the patients with compared with those patients without liver disease. Because acetaldehyde is thought to be the main cause of the DAR, we studied ethanol and acetaldehyde kinetics in 13 patients (6 females, 7 males) with alcoholic liver disease (documented by biopsy, clinical and/or radiological findings, and by quantitative liver function) [galactose elimination capacity (GEC) 4.2 +/- SD 1.0 mg/min/kg; aminopyrine breath test (ABT) 0.14 +/- 0.10% dose x kg/mmol CO2] and 13 age- and sex-matched controls (alcoholics without significant liver disease, GEC 7.1 +/- 0.7; ABT 0.81 +/- 0.35). Clinical signs of acetaldehyde toxicity during the DAR (flush, nausea, tachycardia, and blood pressure drop) were absent in alcoholic liver disease, but clearly evident in controls. Blood ethanol kinetics were similar in both groups, Cmax and area under the concentration-time curve (AUC) being 6.27 +/- 1.82 and 368.9 +/- 72.9 mmol x min/liter in alcoholic liver disease, and 6.62 +/- 1.71 and 377.6 +/- 124.5 in controls, respectively. In contrast, there was a strong (p < 0.001) difference in Cmax and AUC of acetaldehyde, respective values being 33.46 +/- 21.52 and 1463.8 +/- 762.5 mumol x min/liter in alcoholic liver disease, and 110.87 +/- 56.00 and 4162.0 +/- 2424.6 in controls.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Acetaldehyde/pharmacokinetics , Disulfiram/adverse effects , Ethanol/pharmacokinetics , Liver Diseases, Alcoholic/blood , Adult , Aged , Combined Modality Therapy , Disulfiram/administration & dosage , Dose-Response Relationship, Drug , Female , Humans , Liver Diseases, Alcoholic/rehabilitation , Male , Middle AgedABSTRACT
The image of the chronic alcohol patient has changed. Diagnosis is only possible if the doctor assumes alcohol abuse in all his patients. The diagnosis can only be made taking psychiatric, somatic and psychosocial aspects into consideration. Because of the tendency of the patient to deny, an independent history is necessary. Questionnaires, such as the 'Münchner Alkoholismustest', may be helpful. Therapy by the family physician is initiated with a careful somatic, psychiatric and psychosocial work-up, counselling and care. An important factor is the close collaboration between physician and social worker.
Subject(s)
Alcohol Drinking/psychology , Alcoholism/diagnosis , Alcoholism/psychology , Alcoholism/rehabilitation , Denial, Psychological , Humans , Psychiatric Status Rating Scales , Referral and ConsultationABSTRACT
The treatment of patients suffering from alcoholism is notoriously difficult. Ambulatory supportive therapy using disulfiram and supervised by the practicing physician has many advantages. Foremost among these is the maintenance of the patient within his working and social environment. For achievement of longterm abstinence, psychological aspects (patients motivation and agreement, understanding care by the physician) may be more important than the aversive effects of disulfiram. Although disulfiram is generally a safe drug, careful preliminary work-up represents the key to proper assessment of risk versus benefit.
